As Insurance Coverage Increases, ERs Get Busier

Visits to Massachusetts emergency rooms appear to have increased in the aftermath of the state’s push toward universal health insurance. The news is the latest blow to the popular idea that ERs are crowded with the uninsured.

The number of trips to the ER rose by 7% between 2005 and 2007, the Boston Globe reports this morning. The state’s universal health insurance mandate went into effect in 2006.

State officials caution that it’s too soon to say whether there’s a cause-and-effect relationship, or whether this is just a coincidence. But preliminary data for six Boston hospitals also show a rise in ER visits between 2006 and 2008, the Globe says.

In an analysis published last year in the Annals of Emergency Medicine, researchers found overall visits to the ER increased by 26% nationwide between 1996 and 2004. A disproportionate share of the growth came from those whose incomes put them at more than four times the poverty level, and who typically get their care at a doctor’s office. The percentage of uninsured ER patients remained flat, at roughly 15%.

“Focusing the political debate and the health-care debate about the overuse and sometimes the ‘abuse’ of emergency departments by the poor and the uninsured is really missing the point,” the study’s author told the Health Blog last year.

Instead, he and his colleagues suggested, many of those in the ER are patients who can’t get in to see their primary-care doctor for a routine complaint. And, as we noted last fall, the increase in insurance coverage in Massachusetts has coincided with longer waits to see primary care doctors and a decline in the number of practices accepting new patients.

This has important implications for the national health-reform push. If you give everyone insurance, there are going to be more people trying to get in to see primary-care doctors — and, perhaps, heading to the emergency room when they can’t get an appointment.

Comments (5 of 15)

(Well, maybe the primary docs would quibble. Working for nothing might be a bummer for them - but then again, society demands it for the greater good, so the primary docs will just have to do it.)

7:58 pm April 25, 2009

Dr. David Robinson wrote :

"...the increase in insurance coverage in Massachusetts has coincided with longer waits to see primary care doctors and a decline in the number of practices accepting new patients.
This has important implications for the national health-reform push. If you give everyone insurance, there are going to be more people trying to get in to see primary-care doctors — and, perhaps, heading to the emergency room when they can’t get an appointment." Is this mandated health insurance working? http://www.DrDavidRobinson4Health.com

3:46 pm April 25, 2009

RealDoc wrote :

We are already in a shortage situation with Primary Care, even with millions of uninsured patients, and those with insurance not coming as often due to the economy. When the economy improves, and the 26% of citizens with no insurance suddenly expecting an appointment---- THIS WEEK --- the shite will the fan.
Add to that the McDonalds mentality of the US consumer now. If the don't get seen today, and within 5 minutes of arrival, they get bent out of shape.
If you have a Primary Care doctor, don't let go of her/him. Especially if they are younger. I expect a lot of the ones pushing 60 to simply retire in disgust/

11:49 am April 25, 2009

AMD wrote :

There are many reasons why ERs are over-utilized:
- Patients who don't have to pay for care will use the ER more than patients who do pay
- Patients who have no insurance and no hope of paying will use the ER more than those with insurance
- Patients who have no access to primary care will use the ER more than those with good accest to a PCP
- The hospitals that own the ERs have very little reason to discourage inappropriate over use and in most
cases face legal hurdles if they attempt to do so.
The above reasons are FACTS. Some other facts that contribute to the problem:
- ER care for conditions that do not require the ER will always be more expensive than care provided in the primary care setting, often at a ration of greater than 20:1 ($1500 instead of $75)
- Patients have died due to inappropriate overutilization of the ER.
- Government insurance that pays based on the current AMA/RUC payment schedule is the cause of the lack of access to primary care in this country.
- Increasing the number of patients who have government insurance that pays using the current payment schedule will cause primary care providers to attempt to restrict access further or to leave for greener pastures. (Google: Massechusetts primary care shortage)
- Removing a patient's reluctance to use primary care will not help if there is no primary care to use.
The above are FACTS. The following is likely also a fact, but will stated as opinion:
- Current government initiatives to address the primary care access issue will not work as expected due the government's desire to tie increased payments to the primary care physician's ability to meet increased government requirements.

10:56 am April 25, 2009

cassie G wrote :

I LOVE IT! Exactly what I would have predicted. When there's a Free Lunch, everyone wants a giant portion. Medical care is no exception. What next Taxachusetts? Mandatory Lexus ownership?